Demystifying Medicine One Month at a Time

Tag: corporate medicine

Medicine and Business: An Odd Mixture

Dr. Martin Samuels

Twitter is in the news frequently these days, because it’s a primary source of presidential communication. I like Twitter because I follow various health care practitioners and pundits and they often link to interesting articles.

I came across a link to an article (blog post, really) from Martin Samuels, Chair of Neurology at Brigham and Women’s Hospital in Boston and a Professor at Harvard Medical School. The whole post is worth a read if you’re interested in the evolution of American medical education over the 20th and 21st centuries. [The post originally appeared on The Health Care Blog.]

What really stood out to me was a long paragraph of his culled from phrases he’d overheard in various meetings with hospital leaders and business types.

Certain overtones of, well……jargon to say the least.

[I’ve broken the looong paragraph up for you for ease of reading. – ed.]

I’m afraid that if we don’t drill down on our brand equity on the front end, we’ll have to model it out on the back end to align our seemless incentives or pad our ask regarding the co-branding deliverables on the horizon.  As an FYI, this empowerment is going to require an elbow to elbow champion getting under the covers for a 360 of the eRoom to facilitate a paradigm shift in order to achieve buy-in among the stakeholders if we’re going to tip our toe into that water and get the low hanging fruit before our clients incentivize the burning platform with new metrics.

After all, you are the process owner who needs to reach out in the proper bandwidth to push back on the KOL’s or we’ll have to sunset your blue ribbon committee for not trimming the fat on the real-time escalation project.  We need to do more due diligence before we hitch our wagon to that indexed outcome measure, and let’s be careful how we message it and roll it out to the core constituency. We can model that projected gap, but we don’t want to get out ahead of our audience before sensitizing them to the moving target.

Let’s not drop the meat in the dirt but rather vet a pause point, collapse it up to a high level statement and assess the current state in order to connect the dots to achieve the ideal state and have you weigh in at the portal for service oriented architecture.  After all, at the end of the day, we’ll have more skin in the game and be in a better space if you walk the stakeholders though it so that they can leverage their halo to birddog that from 10,000 feet.

If you could create a placeholder to move the needle in the continuous quality improvement initiative, some heavy lifting might give us a report card so that there can be the accountability for a decent ROI, unless the co-branding produces a choke point so severe that the balanced score card causes a culture change, one by each.  Just between you and I, you need to parking lot that issue, take the deep dive and put the rubber to the road with a degree of commonality that will re-engineer a sea change in our SWOT analysis so that we bake it into the budget of the high level implementation group.  We have to move the ball down the field and prevent leakage.  Net-net there is value added for a win-win, rather than a zero-sum game.

You can manage the matrixed organization on the frontline and in the back office. With central discipline and local control we can achieve savings and margin, while penetrating that segment of the market.  A lot of what we have to do to reduce our trend is blocking and tackling in different spaces. Bottom line on top, if I don’t report to myself, we could really take a haircut before we can trim the fat out of the box and shift the culture beyond this pilot demonstration program.  That having been said, the PEST analysis shows that if you step up to the plate and evangelize the brand, we can be about the business of creating a placeholder of new buckets with more vertical silos so that we can finally tell whether we are on foot or on horseback.

Comparing apples to apples, it is clear that this is not a plug and play culture, so that you’ll have to hold your nose and jump in order to filter the noise and incentivize the process owners in a more granular fashion before it becomes a major mission drag.  A bread crumb has been forming so let’s put some stakes in the ground to leverage our insights as enablers of change to circle back on a more granular view, and tee up our clinical levers to mine insights from the benchmarks and beat the waste out of this process.  We will cleanse our application platform and get ready for the first wave of ambulatory e-care care go-live across the family and take advantage of the elbow-to-elbow support of the super-users and be back to 100 percent productivity by the second week.

Having said that, we traffic-lighted that report so you can optimize the outcome metrics.  If we can get the whole group on board in this arena we can try to boil the ocean with a six sigma culture change.  We mean to hit this one out of the park and get some substantive returns in the coin of our realm to avoid any mission creep.  It’s a non-starter to analyze the dashboard for crosswalking noise, so we need to slice and dice our organic growth, peel the onion and hardwire the initiative with more boots on the ground. If this could be the pause point for a new value initiative, that’s where the metal meets the road.

Let’s reach out, using our optimized tool kit to go anything north of zero and put a hard stop on this turn-key operation. If you would like to get some trend lines and traction from this piece, I can ping you a copy of my deck.

Oy vey.

Blue Light Special on Primary Care?

NPR and the Wall Street Journal ran stories this week on Wal-Mart’s attempt to re-shape delivery and provision of primary medical care in the U.S.The company is soliciting proposals from vendors that offer products and services designed to deliver efficient and inexpensive primary care to the market place.

Your new doctor's office?

Then, in an “Oops” moment, the company’s VP for health and wellness issued a statement the next day clarifying his intent: “We are not building a national, integrated, low-cost primary care health care platform.” A company spokeswoman said that the request for proposals was “overwritten and incorrect.”


Let’s start with basics: Wal-Mart is the world’s largest retailer. It employs around two million people, far more than any other private sector company in the world. It has combined annual sales of over $400 billion.

Wal-Mart’s success is in large part due to its massive supply chain and innovative inventory logistics. It knows what its customers want, it negotiates strongly on price, and then stocks the items in huge quantities, passing on the savings to customers.

This strategy has fueled unprecedented growth and changed many communities in which the corporation operates.

This is not without controversy: Wal-Mart pays its employees lower than average hourly wages, and does not offer health insurance to a significant portion of its workforce. The company is said to be responsible for 10% of the total exports of China; one website reports that 80% of Wal-Mart’s suppliers are in China.

What’s any of that got to do with health care? I find it an interesting question, one that begets further ones:

  1. Could Wal-Mart use its strategic and logistical excellence to build a robust and cost-effective primary care network?
  2. Would doing any of this improve the company’s corporate image? Imagine Wal-Mart working in service to our national goal of “bending the cost curve” on health care spending, and while doing so providing basic health care services not only to its currently neglected employees, but to the population at large…
  3. Is ‘straightforward’ primary care amenable to widget-ization? Certainly most doctors would argue “NO!”

I will be eager to follow the travails of Wal-Mart as they pursue this enterprise. It may be courageous, outlandish, innovative, and special, or it may become Wal-Mart’s Waterloo.

I just hope that whatever happens with health care, they do a better job than they did with this Chanukah display that’s circulating the Internet.

Giving people what they want?


Good news/bad news from the world of medicine last week. Both stories from the business section of the NY Times and “business of health care” reporter Reed Abelson.

The bad news first: Huron Hospital, a community hospital in East Cleveland, will be closed down by its corporate overlord, the Cleveland Clinic. Like many community hospitals, Huron has declining numbers of admissions and isn’t staffed or equipped to provide the cutting edge care [e.g. transplant, cardiac surgery, or interdisciplinary cancer treatment] favored by behemoth academic medical centers.

I’m sentimental about Huron’s closure for many reasons:

  1. One man's ceiling is another man's floor?

    Further evidence of Cleveland’s decline. After all, Cleveland ranked #5 on Newsweek’s list of dying American cities.

  2. Huron was originally built on part of the estate of John D. Rockefeller, one of America’s original “robber barons.” Rockefeller also bequeathed a nice sum to start a university on the south side of Chicago.
  3. I rotated at Huron as a medical student, working in the ER; I learned a thing or two about suturing and triage.

The Cleveland Clinic makes it clear that closing the inpatient hospital is a business decision. CEO Toby Cosgrove acknowledges that the decision is a difficult one. The hospital is not only considered a local public resource; it’s the largest employer in the community of East Cleveland.

The news is not entirely bleak, however: The Clinic plans to open an outpatient family health center on the site. “When we took over the hospital, we signed up to look after this community,” Cosgrove said.

Contrast the Clinic’s decision with that of Blue Shield of California. The non-profit health insurer made news by unilaterally declaring that it will limit its annual “profit” to a maximum of two percent of revenues. Monies earned over that figure are plowed back to the company’s members, most often in the form of credits on premium payments.

This in effect helps subsidize the cost of insurance for members of that plan.

Sounds good, but you have to wonder:

If a non-profit insurer is making enough “profit” to offer premium credits, you’d think they could just charge lower premiums in the first place. After all, when we talk about annual double digit inflation in health care, isn’t our insurance premium the first place we feel the pain?

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